Anatomy of Kidneys and Ureters Flashcards
what do the ureters do?
allow passage of urine from kidneys to bladder
where is the bladder located?
pelvis
what are the functions of the urinary system?
regulation of fluid/ blood volume regulation of osmolarity regulation of ion concentrations regulation of pH production of hormones for BP regulation and production of RBCs vitamin D metabolism pathway
what is normal GFR?
125ml/min of blood
180L/day
what is normal urine volume?
1L/day
what does the kidney receive?
25% of cardiac output
consumes 7% of oxygen
length of kidney
10-13cm
Where are the kidneys located?
retroperitoneal
upper posterior abdomen
in extraperitoneal connective tissue
lateral to vertebral column
what does retroperitoneal mean?
lie behind the peritoneum
what is the peritoneum?
lining of the abdo cavity
supine location of kidney
T12-L3
right kidney is lower than left due to liver
difference between the 2 kidneys
left is longer and slimer than right
what causes alterations in the location of the kidneys?
respiration and body position
what happens to the kidney position in respiration?
kidneys closely associated with diaphragm so when it contracts
on inspiration they move inferiorly - 2.5cm
renal hilum location
located at L1 - 5cm from midline
rib levels of kidneys
left reaches rib 11 but right only 12
L1
transpyloric plane
where are the lower poles of the kidneys
L3-4
on right few cm superior to iliac crest
clinical examination of kidneys
not dull to percussion due to overlying colon
bimanually between 2 palpating hands - balloting
normally impalpable
when kidney can be felt (especially left) may indicate pathology
what are the surfaces of the kidney?
anterior and posterior surfaces
inferior and superior poles
what is the hilum of the kidney?
structures run from and to the kidney through here
on anteromedial side
vertical cleft entrance
kidney sinus
space within kidney, runs past hilum
what is in the sinus of the kidney?
pelvis calices vessels nerves fat
what enters and leaves through the renal hilum?
renal vessels
lymphatics
nerves
ureter
what covers the kidney
smooth surface covered by fibrous capsule - easily removable
what makes up the internal structure of the kidney?
cortex and medulla
what is the renal cortex?
continuous band of pale tissue that surrounds the medulla
has extensions that project into the medulla, dividing it into segments - renal pyramids
renal pyramids
bases face the medulla and tips project inwards
what surrounds the renal pyramids?
minor calyx
minor calyx
fuse to form major calyx
major calyx
unite to form renal pelvis
what is the renal pelvis?
funnel shaped superior end of ureter
where is the renal sinus located in relation to renal hilum
deep to it
which structures are retroperitoneal
suprarenal - adrenal glands aorta/ inferior vena cava dueodenum pancreas - except tail ureters colon kidneys oesophagus rectum
Mnemonic = sadpucker
what is found anterior to the right kidney
adrenal gland - superior liver 2nd part of dudenum right colic flexure ascending colon
what is found anterior to the left kidney?
adrenal gland - superior stomach spleen pancreas jejunum left colic flexure descending colon
what separates structures from the kidney
some are separated by layer of peritoneum
some are directly against the kidney
hepatorenal recess
on the right
place where intra-abdo fluid can collect
lienorenal ligament
on left
mesenteric fold
contains splenic vessels
where do the kidneys lie?
on top of the posterior abdominal wall muscles
what is found posterior to the kidneys?
diaphragm costodiaphragmatic recesses posterior abdo wall muscles transversus abdominis nerves
what are the posterior abdo wall muscles?
psoas and quadratus
what nerves pass posterior to the kidney?
subcostal vessels and nerves of 12th ribs
iliohypogastric
ilioinguinal
how many layers surround the kidney?
4
what are the layers that surround the kidney?
renal capsule
perinephric fat
renal fascia
paranephric fat
renal capsule
attached to kidney itself
perinephric fat
extends into renal sinus
surrounding renal capsule
protects
renal fascia
encloses kidneys and adrenal glands
separates perinephric and paranephric fat
another fascia layer within this separates the adrenal gland and kidneys
what is the blood supply to the kidneys?
renal arteries which branch from the abdominal aorta
what level do the kidney arteries branch from the aorta?
L1
left slightly higher than right
just below origin of superior mesenteric artery
accessory arteries
30% population
come into kidneys outside of hilum - extrahilar insertions
from more inferior along aorta or along iliac artery
branches of the renal artery
splits into 5 when enters the kidney
what are the vascular segments of the kidney?
apical/ superior caudal/ inferior upper anterior middle anterior posterior no collateral circulation between them
benefit of vascular segments
surgically resectable
right and left renal arteries
right renal artery longer and passes posterior to inferior vena cava
left renal vein longer than right
renal veins
multiple renal veins fuse together to form the left and right renal veins
communicate across segments
location of renal arteries and veins
arteries are posterior to veins
left renal vein
longer
crosses midline anterior to abdominal aorta and posterior to superior mesenteric artery
risk of compression
what does the left renal vein drain
left gonadal vein
left suprarenal vein
but on the right they drain directly into IVC
compression of left renal vein
caused by lymphodenopathy
aortic aneurysm
etc.
causes varicocele
what is the lymphatic drainage to the kidney?
lateral aortic lumbar nodes
para caval
para aortic nodes
follows venous drainage
what is the innervation of the kidneys?
parasympathetic and sympathetic
celiac and intermesenteric plexuses
splanchnic nerves
pain fibres from ureteric pelvis
structure of renal hilum
front to back:
vein
artery
pelvis of ureter
what does the renal pelvis receive?
each one receives 2 or 3 major calyces
each major calyces receives 2 or 3 minor calyces
usually all collapsed
what happens when there is abnormal distension of calyces
hydronephrosis
minor calyces losse concave shape
renal pelvis distended
transpyloric plane
imaginary line
halfway between suprasternal notch and pubic symphysis
L1
what does the transplyoric plane pass through
9th costal cartilage end of spinal cord 2nd part of duodenum neck of pancreas fundus of gall bladder sphincter of oddi lower border of spleen superior mesenteric artery origin of portal vein
what are the ureters?
muscular tubes that transport urine from kidneys to bladder
what lines the ureters
transitional epithelium
what lines the bladder?
transitional epithelium
course of ureters
25cm long from renal pelvis to entrance of bladder at ischial spine
retroperitoneal course in line with transverse porcesses
medial to psoas muscle
where do the ureters enter the pelvis?
bifurcation of common iliacs
in front of sacroiliac joint
runs on lateral wall of pelvis in front of internal iliac artery
ureter from renal pelvis
ureteropelvic junction
ureters in females
ureters pierce the cardinal and broad ligaments of uterus
what structures are anterior to the ureters?
ovarian/ testicular vessels
right colic vessels and ileocolic vessels
left colic vessels
uterine vessels
what structures are posterior the the ureters?
psoas major
common iliac artery bifurcation - internal iliac
where are the constrictions of the ureters?
where the ureters leave the kidney - ureteropelvic junction
where ureters cross common iliac vessels at the pelvic brim
where the ureters enter the bladder
what is the clinical relevance of constrictions of the ureters
where calcifications/ calculus or blood clots can get stuck
blood supply to ureters
multiple arteries as it descends:
1. aorta
2. renal arteries
3. gonadal (ovarian/ testicular) arteries
4. common and internal iliacs
5. inferior vesicle artery - branch of internal iliac, supplies part of bladder as well
form a longitudinal anastomosis
venous drainage of ureters
renal and gonadal veins
water under the bridge
ureter passes under uterine artery which can be potentially injured at ligation of the artery for hysterectomy
where can the ureter be damaged?
pelvic brim
hysterctomy - uterine artery
vesical uretero junction during C section
lymphatic drainage of ureters
follows arterial supply
lateral aortic lumbar nodes
common iliac vessel nodes
external and internal iliac vessel nodes
loin to groin pain
classic ureteroteric pain
comes and goes
motor innervation of ureters
visceral efferent fibres from sympathetic and parasympathetic sources
sensory innervation of ureters
visceral afferent fibres of ureter return to T11 and L2 spinal cord level
where is ureteric pain felt?
loin to groin regions cutaneous areas supplied by T11-L2 posterior and lateral abdo wall pubic region scrotum or labia majora proximal anterior aspect of thigh
what causes ureteric pain?
obstruction and or distension of ureter
from renal colic
nephrostomy
drains urine from kidney if ureters are blocked
